‘Kissing bug’ sickens more in Los Angeles than Zika and few know they have it – deadly Chagas disease

This insect bites people near the lips or eyes, inserts bacteria, then about 20 years later, the victim suffers a heart attack. Olive View-UCLA Medical

March 28, 2016 |by Susan Abram | Daily News, Los Angeles

This insect bites people near the lips or eyes, inserts bacteria, then about 20 years later, the victim suffers a heart attack.  Olive View-UCLA Medical Center is working to help detect Chagas. The clinic is holding community screenings across the San Fernando Valley to find people who may be infected.

Some call it the kissing bug because it leaves a painless bite near a sleeping person’s lips.

But among health experts, including those from the federal government, the cone-headed Triatomine is no prince awakening a sleeping beauty. It’s an assassin, because it leaves behind a parasite in its love bite that can be deadly.

Photos of the dime-size insect hang inside Dr. Sheba Meymandi’s medical office as if on a wanted poster. The bug, she said, carries the Chagas disease, which can cause heart failure if left untreated.

An estimated 300,000 people across the United States may have Chagas disease, Meymandi said, and the only place in the nation where it’s treated is the clinic she oversees at Olive View-UCLA Medical Center in Sylmar. Started in 2007, the Chagas clinic has treated 200 people, but Meymandi and her team said they are ready to take on more patients.

That’s why she and her staff are working with primary physicians at the four hospitals and 19 health clinics overseen by the Los Angeles County Department of Health Services. In addition, Providence Health & Services will offer Chagas screenings at a dozen free health clinics on Sundays at churches across the San Fernando Valley for the rest of the year. An upcoming screening will be held from 1 to 5 p.m. April 3 at New Hope of the Nazarene, 15055 Oxnard St, Van Nuys, California.

“It’s very clear that we need to diagnose early and treat early before the onset of complications,” said Meymandi, a cardiologist. Ten percent of those with Chagas suffer from heart failure, one of the most expensive conditions to treat, costing $32 billion year nationwide, she said. That figure could rise to $70 billion by 2030.

Chagas disease was once considered exotic, but more is known about it now than about the Zika virus. Still, most people have no idea they have it or, once they do, lack information about where to receive treatment, Meymandi said.

The disease is most common in rural Mexico and Latin America, researchers have said, adding that it kills more people in South America than malaria.Meymandi said anyone who was born in Mexico or South America should have a blood test.

But U.S.-born residents also are infected. The insect is present in more than 20 states. At least 40 percent of raccoons tested in Griffith Park carried Chagas disease, Meymandi said.

“Most of the people we see and treat in the U.S. have had it for decades,” Meymandi said. “We have the bug here, we have the parasite here. You can definitely acquire Chagas in the United States.”

An infected insect, which hides in dwellings made from mud, adobe, straw or palm thatch, crawls out at night to feed on blood. It is called the kissing bug because it feeds on a sleeper’s face, then defecates on the wound, leaving a parasite behind.

Infection takes place when the parasite enters the body through mucous membranes or broken skin, caused when the sleeper scratches the wound, eyes or mouth, according to the federal Centers for Disease and Prevention. The parasite can lie dormant for years, then cause heart disease, and if not found and treated, death.

Symptoms can include fever, fatigue, body aches, headaches, rash, loss of appetite, diarrhea and vomiting. But sometimes there are no symptoms until decades later.

Only two drugs exist to treat Chagas disease, and neither is approved by the U.S. Federal Drug Administration yet, though both can be provided through the CDC, Meymandi said.

“It’s very simple to treat,” Meymandi said. “But the process to go get the drugs is a challenge.”

Jose Duran, a Bellflower resident, said he learned he had Chagas disease after he tried to donate blood seven months ago. He said he would have never known he had Chagas disease otherwise. He had no symptoms.

“I went to donate blood for the first time, because I heard it was good for you to donate once in a while,” he said. Then he received a phone call.

It’s not uncommon for people to learn they have Chagas disease after donating blood, Meymandi and others said. In 2006, the Red Cross isolated 21 cases of Chagas in Southern California donors. In 2007, the figure more than doubled to 46. In 2008, there were 55 cases.

The National Red Cross would not provide additional figures.

“I got scared. I was like, wow, what is this?” the 40 year old Duran said of his reaction,when he learned what he had.

As a child, Duran lived on a ranch in Querétaro, a small state in north-central Mexico. His brother also tested positive for Chagas. He doesn’t remember being bitten, he said.

Duran was referred to the Chagas clinic and, after two months of treatment, learned Thursday he was in good health.

“Most people don’t know they have this,” he said. “If they get tested, they can get well.”

#SayNOtoPESTICIDES!

 

Deadly CHAGAS: An Emerging Infectious Disease Threat In U.S.

October 1, 2015 | by Judy Stone | Forbes

Chagas, a parasitic disease, is the latest invisible killer infection to be recognized as a growing threat here. The infection is transmitted by the Triatomine bug, known as the “kissing” bug. The bugs infect people through bites—often near the eyes or mouth—or when their infected feces are accidentally rubbed into eyes or mucous membranes. Some transmission occurs from mother to child during pregnancy. Occasionally, transmission is through contaminated food or drink.   Triatoma sanguisuga – CDC/James Gathany

Most people in the U.S. with Chagas disease probably became infected as children, living in Latin America. The infection often has few symptoms early on, but after several decades, strikes fatally, often with sudden death from heart disease. I suspect that, similar to Lyme disease, the magnitude of disease and deaths from the protozoan parasite, Trypanosoma cruzi, which causes Chagas disease, is unrecognized in the U.S.

 2014 map of blood donors testing positive for CHAGAS disease. 

In Latin America, however, up to 12 million people might be infected, with a third going on to develop life-threatening heart complications. Chagas is a major cause of congestive heart failure and cardiac deaths, with an estimated 11,000 people dying annually, according to the WHO.

There are an estimated 300,167 people with Trypanosoma cruzi infection the U.S., including 40,000 pregnant women in North America. There are 30,000-45,000 cardiomyopathy cases and 63-315 congenital infections each year. Most of the people come from Mexico, El Salvador, Guatemala, Honduras, or Argentina; Bolivia has the highest rate of Chagas in the world.

But in the U.S., we don’t often think of Chagas. Even as an infectious disease physician, I’ve never treated anyone with it, and it is not on my radar. So when a physician sees a patient who may have come to the U.S. as a child, and now has diabetes and hypertension, he or she is likely to attribute the heart disease to that and not look for infection. In fact, though, there are large pockets of undiagnosed disease. For example, a survey in Los Angeles of patients with a new diagnosis of cardiomyopathy who had lived in Latin America for at least a year, found 19% had Chagas disease, and they had a worse prognosis than those without the infection.

There are other reasons Chagas is overlooked. One is that Chagas is not a reportable disease except in four states, and Texas only began reporting in 2010. Most cases here have been detected by screening of blood donations, which has found about 1 in every 27,500 donors to be infected, according to CDC. However, a 2014 survey showed “one in every 6,500 blood donors tested positive for exposure to the parasite that causes Chagas disease.” A map of positive donations is here. While the triatome bugs are most common in the southern half of the U.S., they are actually quite widespread, as shown here.
Much bigger barriers to diagnosis are social and cultural. Many patients lack health insurance. Others are undocumented immigrants fearing deportation. Health literacy and language barriers are huge. There is a stigma associated with the diagnosis, as there is for many patients with TB, as Chagas is associated with poverty and poor living conditions. As Daisy Hernández noted in her excellent story in the Atlantic, “it’s hard, if not impossible, for moms with Chagas and no health insurance to see the doctors who would connect them to the CDC” and “patients don’t necessarily have savings in case they have adverse reactions to the medication and can’t work.”

There are pockets of Chagas in the states, including Los Angeles, the Washington metropolitan area, and the Texas border, where there are large immigrant communities from endemic areas. But I suspect that with climate change, we’ll see more Chagas in the southwest U.S., as more triatomine bugs are found further north. One recent study found more than 60% of the collected bugs carried the Trypanosome parasite, up from 40-50% in two similar studies. There are also now seven reports of Chagas infection that are clearly autochthonous, or locally acquired. University of Pennsylvania researcher Michael Levy has shown that bedbugs might be capable of transmitting Chagas, but no one has shown that they actually do. Entomologist and Wired author Gwen Pearson nicely explains why bedbugs are an unlikely vector and notes that you “far more likely to be injured by misusing pesticides to try to exterminate” them.

There’s more bad news. Treatment for Chagas is effective if given early in infection, although with significant side effects. There is no effective treatment for late stages of gastrointestinal or cardiac disease. A newly released study showed that benznidazole was no more effective than placebo in reducing cardiac complications, even though it reduced levels of parasites in the blood.

   Trypanasoma cruzi parasite in heart tissue – CDC

The two drugs available to treat Chagas, benznidazole and nifurtimox, are not yet FDA approved and are only available through the CDC under investigational protocols. Both carry significant side effects. Treatment of children with early Chagas is generally effective but, as with many drugs, treatment is hampered by lack of data on pediatric dosing and limited formulations. There is little research funding for new drug development, with less than US $1 million (0.04% of R&D funding dedicated to neglected diseases) focused on new drugs for Chagas disease, according to the Drugs for Neglected Diseases Initiative (DNDi).

Where do we go from here? The most immediate and cost-effective proposals are to increase surveillance for disease and screening of high-risk populations. Since the most effective treatment is given early in the course of infection, screening of pregnant women and children is a priority, as is education for these women and Ob-Gyn physicians.
While there is no effective treatment for advanced disease, efforts are underway to develop a vaccine against Chagas. The National School of Tropical Medicine at Baylor College of Medicine just received a boost from a $2.6 million grant from the Carlos Slim Foundation for their initiative.

Chagas, like sickle cell, highlights disparities in access to screening and early treatment for serious illnesses disproportionately affecting the poor and people of color. While a moral and ethical issue, the choices made to gut public health programs for “cost saving” will also be unnecessarily costly in the end.

#SayNoToPesticides!

Messing with BedBugs’ Genes Could Carry Other Risks?

Bed Bugs Will Outlive All Of Us Unless We Screw With Their Genes

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photo:  Bluejake/Sara Bibi/Gothamist

Bed bugs, like cockroaches and new seasons of The Bachelor, seem impossible to eradicate from the face of the Earth, no matter how many exterminators our landlords call to spray that one time and then never, ever again. But Science says there’s some small hope for the extinction of a moviegoer’s biggest fear—screwing with their genome.

Scientists have managed to map the genome of the common bed bug, revealing some fun things about the little suckers. For instance, bed bugs are actually able to break down toxins, like the ones an exterminator might use, to render them harmless, allowing them to survive even when you try to whack them with bug killer. They’ve also been MUTATING, producing genes that make them resistant to certain insecticides and making it all the more difficult to eradicate an infestation. Another fun fact is that bugs’ genes vary from location to location—a Brooklyn bed bug will have a different genetic sequence from a Queens bed bug, though both are equally disgusting.

Bed bugs also inbreed, and their sex is quite violent. This violent sex has been well-documented, and for those of you who have not yet seen Isabella Rossellini’s bed bug porno, you’re welcome, and sorry:

The takeaway here is that bed bugs have been able to hold us hostage for a long time, but scientists might be able to murder them, provided they make a few genetic tweaks. First, though, let’s kill all the mosquitoes.

[A. Steiner:  So…..Messing with Genes Could Carry Other Risks – YES!]

#SayNOtoPESTICIDES!

DEADLY “KISSING BUG” HAS INFILTRATED FLORIDA…aka “Love Bug” and cousin to the BEDBUG – all transmit DEADLY CHAGAS disease

  
November 28, 2015 

The CDC reports the Kissing Bug has been discovered in the Southeastern U.S., including Florida. (Source: CBS4)

  
MIAMI (CBSMiami/AP) — New warnings have been issued by The Centers for Disease Control and Prevention about the potentially deadly Chagas Disease from the kissing bug in Florida.

The bugs have invaded the southern United States, including Florida.

The infected inch-long Triatomine bugs carrying the parasite can pass it through bites. The bites are typically around the mouth and face, which is how they get their nickname “kissing bugs.”

Once in the body, the parasite can remain hidden for years, or even decades, eventually resulting in heart disease.

According to the CDC, it estimates about 8 million people are infected worldwide. Most of the infected are reportedly in Central and South America.

The CDC reports that infections have been reported in Arkansas, Arizona, Massachusetts, Tennessee and Texas.

Dogs Lives Matter – Could be Thousands Infected with Chagas

Studies show dogs highly at risk for deadly Chagas disease

Stott Friedman, Eva Parks and Dr. Seema Yasmin | November 17, 2015

An NBC 5 investigation found hundreds of dogs in Texas are infected with the deadly parasite that causes Chagas disease.

For months, NBC 5 Senior Investigative Reporter Scott Friedman teamed up with The Dallas Morning News’ Dr. Seema Yasmin to investigate a hidden threat known as The Kissing Bug, which has infected at least a dozen people in Texas.

In Texas the disease has infected family pets; prized hunting dogs and even military K-9’s that protect U.S. troops. Right now, no one seems to know exactly how many more dogs could be at risk.

Meet Kiska, a Japanese Spitz, a rare dog breed kept alive with a pacemaker.

“My husband called me and said Kiska fell over,” said Cora Fortin, who at the time lived in Plano.

Kiska kept collapsing. A vet in Plano said Kiska’s only hope was a pacemaker operation at Texas A&M in College Statio“She was passing out all the way down there, so we didn’t know if she would make it,” said Fortin.

Kiska survived but what caused her heart to fail was a bigger surprise. It was Chagas disease, caused by a rare parasite transmitted by kissing bugs.

Chagas is usually found in tropical climates of Mexico, South and Central America. But cases of locally transmitted Chagas disease have not been documented in Texas until more recently.

Fortin wants people to know dogs can get this disease in Collin County. But it’s not just there.

All over the state there are cases of dogs getting sick with Chagas, many of them showing up for treatment at the Texas A&M Veterinary School.

“I diagnosed a little Yorkie that lived in Downtown Dallas not too long ago, so yes, it’s everywhere,” said Dr. Ashley Saunders, a veterinary cardiologist with Texas A&M.

In some cases the dogs are so sick there’s no saving them.

“I think we shock a lot of people and I think it’s one of the hardest things for me is we have some clients who come in and they have no idea the disease even exists,” said Saunders.

Researchers at Texas A&M tested dogs at animal shelters statewide and found many shelter dogs have Chagas.

“The study that just wrapped up, about 10 percent of dogs across the state were infected,” said Sarah Hamer, Texas A&M researcher.

Officially the Texas Department of State Health Services reports 351 dogs with Chagas since the state began tracking it two years ago.

Tom Sidwa, State Public Health Veterinarian with the Texas Department of State Health Services, said there’s no doubt Chagas will grow and kill more dogs in the state.

However, it’s hard to estimate the total number of dogs infected because many dogs are never tested.

“So many of the dogs seen are young dogs that are just really hit hard by the disease … and sometimes, sudden death,” said Sidwa.

It’s already killed U.S. Military working dogs in Texas.

At Lackland Air Force Base in San Antonio, about 70 military working dogs have been infected in the last nine years.

Bomb, drug and patrol dogs train at Lackland to serve with U.S. troops all over the world.

“When one of these dogs become sick, and for any reason can’t do its job that’s a major loss because that whole team is taken out they’re not able to perform their mission,” Col. Cheryl Sofaly, Director of the DOD Military Working Dog Hospital at Lackland Air Force Base.

Some dogs with Chagas are still working, but ones that develop more serious symptoms are retired from service.

“If they’ve got heart disease that makes it very hard for them to do that job effectively,” said Sofaly.

Losing a military dog is expensive. It costs about $20,000 to train each one.

When Chagas first surfaced here in 2006, military veterinarians worked to track down the source.

A search of the base turned up bugs in and around kennels where the dogs sleep.

Dogs that sleep outside and hunting dogs are more likely to be infected. The bugs like wooded areas and bite at night. Because dogs sometimes eat infected bugs it may be even easier for them to become infected than people.

That’s how the Fortin’s suspect Kiska got sick.

“One day she brought this strange looking insect into the house,” said Fortin.

Before they could snatch it away, she ate it.

Recently, Kiska has developed more symptoms including an enlarged heart.

“We just really don’t know what’s going to happen next,” said Fortin.

There’s no cure, so the Fortin’s appreciate every day.

“She’s totally a member of the family and we will be devastated when the day comes we lose her,” said Fortin.

At Lackland, the military has been able to reduce the number of new cases of Chagas by putting up screens around the kennels and by treating the areas with pesticides, but they are still seeing about 4-5 new cases a year in dogs.

To protect your pets, veterinarians suggest keeping them indoors late at night and don’t let them sleep outside.

Keep piles of wood and brush away from your home and any area where small animals might nest will attract the bugs.

If your dog coughs, has shortness of breath and has fainting spells, it’s worth asking your vet about Chagas.

[Reporting from behind.  A. Steiner.]

Where have they been? Deadly ‘kissing bug’ spreads to other states besides Texas

Fox_Boston   November 23, 2015 | Boston, MA

A deadly insect known as the “kissing bug” has recently been reported in Georgia and possibly Pennsylvania, as well as Texas.

Texas officials said recently at least 12 people in their state have been infected with a parasite connected to the insect.

According to the Centers for Disease Control and Prevention (CDC), the insects — called triatomine bugs — may carry a parasite that causes Chagas disease, which — if left untreated — can cause sudden death. Kissing bugs get their nickname because they favor biting human faces and lips at night.

It was not clear exactly where in Georgia the insect was reported, according to the Atlanta Journal-Constitution.

In Pittsburgh, after an on-air report about the bug, viewers sent in photos to WPXI  and a curator at the Pittsburgh Zoo said the photos did appear to show “kissing bugs.” However, the station reported that no cases of Chagas disease had been confirmed in Pennsylvania.

Texas

How to protect against the ‘kissing bug’

The CDC says that the bugs are typically found anywhere from under porches or cement, in animal burrows, chicken coops or even outdoor dog houses or kennels.

To keep the insects away from your home, the CDC says to use the following precautions:

  • Seal cracks and gaps around windows, walls, roofs, and doors
  • Remove wood, brush, and rock piles near your house
  • Use screens on doors and windows and repairing any holes or tears
  • If possible, make sure yard lights are not close to your house (lights can attract the bugs)
  • Seal holes and cracks leading to the attic, crawl spaces below the house, and to the outside
  • Have pets sleep indoors, especially at night
  • Keep your house and any outdoor pet resting areas clean, in addition to periodically checking both areas for the presence of bugs

If you think you’ve found a triatomine bug, the CDC urges not to touch or squash the bug, but place a container on top of it, slide the bug inside and fill it with rubbing alcohol.

If you do not have rubbing alcohol available, the CDC says to freeze the bug in the container before you take it to your local extension service or university laboratory.

Report: Deadly ‘kissing bug’ in North Carolina

Charlotte, NC | November 23, 2015

chagas-bug

A deadly insect know as the “kissing bug” has made it’s way to North Carolina, according to the CDC.

The bug has been in headlines lately for popping up around the south, especially in Texas.

It carries a parasite that causes ‘Chagas’ disease.

The CDC says now is a good time to double check around the house for cracks and holes, because they tend to hide under beds and mattresses.

If you find the bug the CDC says do not touch it.

Put a container on top of it and fill it with rubbing alcohol, or freeze it.

This bug could give you the ‘kiss’ of death

Misstated info on Video 1.5 Million in US infected CHAGAS & 50 million World Wide with 15 to 20,000 deaths annually.

Nov. 19 Video transcript provided by Newsy.com

Texas health officials say “kissing bugs” have infected at least 12 people with a parasite that has the potential to kill.

“I’ve never left the United States. I’ve never even been on a cruise,” a woman told KXAS.

 photo

Video still via Newsy

“I was infected right here in Texas.”

Kissing bugs get their nickname because they favor biting human faces and lips at night. The parasite they leave behind causes Chagas disease. The bugs and parasite are usually only found in the tropics.

The disease has an acute phase much like the flu to start. Then it transitions into a chronic phase, during which up to 30 percent of people develop heart problems and 10 percent develop gastrointestinal issues.

In rare cases, Chagas disease can end in death.

The Centers for Disease Control and Prevention estimates 8 million people in Mexico and Central and South America are infected with Chagas disease, yet most don’t even know it.

There’s no approved treatment for the disease. The CDC only has experimental drugs, which reportedly can be up to 85 percent effective, but they have to be taken soon after a person is infected.

Most counties in Texas have reported kissing bug sightings. (Video via KXAS)

KXAS reports the rise in infections is likely due to the growth of suburbs on land infested with the bugs rather than the bugs coming into the state.

This video includes images from Glenn Seplak / CC BY 2.0 and Simon Fraser University – University Communications / CC BY 2.0.

The Hidden Threat: The Kissing Bug

bugcut-2400

These seven tropical diseases are closer to home than you think. Lurking in your Dallas-area backyard is Chagas disease, caused by a parasite that infects more than 300,000 Americans. The disease can cause heart failure and death in humans and dogs and is often missed by doctors.

Or maybe you live near a typhus hot spot such as Houston? Spread by rat-biting fleas, typhus causes headaches, fever, chills and a rash.

Farther north, close to the Oklahoma border, Texans have been plagued by skin boils and sores caused by a disease called leishmaniasis — also known as the Baghdad boil. Many have suffered for years because doctors have misdiagnosed them with staph infections and given them the wrong treatment.

You’ve already heard of West Nile virus, another tropical disease that has strong-armed its way into Texas. West Nile virus has infected close to 5,000 Texans since 2002. But the real number of humans infected is probably 25,000, since about 80 percent of people who are infected don’t show symptoms.

Now get ready to meet two new tropical diseases on their way to you. Dengue and chikungunya are viruses spread by mosquitoes. Common in the Caribbean and South America, they’re being lured to the U.S. by a combination of rising temperatures and poverty.

Don’t expect your doctor to save you from these tropical diseases. Medical students spend a few days learning about this group of infections, and studies show that many health care providers in Texas and the U.S. are unaware that these infections are here or on their way.

Americans living with diseases such as Chagas can go undiagnosed for many years, by which time the infection can cause irreversible damage to the heart.

Dr. Seema Yasmin’s reporting on this project was undertaken while she was a National Health Journalism Fellow at the University of Southern California’s Center for Health Journalism. Yasmin, a physician and former CDC epidemiologist, is a professor at the University of Texas at Dallas.

Not just tropical

Kissing Bug

Chagas disease

About: A parasite spread by the blood-sucking kissing bug — so-called because the bug likes to bite us on the face around the lips and eyes. Kissing bugs poop where they eat, and when we scratch the bite, we rub the poop and the parasite into our skin. About a third of people infected with the parasite, called Trypanosoma cruzi, develop heart disease. One in 10 suffer digestive or nerve issues.

 

Spread by: The dime-sized kissing bug, which lives in rats’ nests and wood piles and in the nooks of furniture and cracks in homes.

 

Symptoms: Swollen eyelids, breathing problems, chest pain, heart failure, death.

 

Testing: Blood test.

Treatment: Anti-parasitic drugs that can be 60 percent to 85 percent effective if given early.

 

Illustrations by Troy Oxford/The Dallas Morning News

A Fatal Flaw

Blood supply system lacks key safeguards against dreaded Chagas disease

Blood centers screen first-time donors for the disease with a one-off test. Donors who test negative are never screened again and are able to donate blood repeatedly.

New technology that inactivates contagious diseases in donated blood is used to protect the blood supply in some states but not in Texas.

bloodStaff-2400

Chagas disease, caused by the parasite Trypanosoma cruzi, can lead to heart failure and sudden death. Globally, about 11 million people are infected. An estimated 300,000 live in the U.S. The parasite can hide in heart muscle and the gut for two to three decades before causing symptoms.

One in every 6,500 blood donors in Texas are infected with the parasite that causes Chagas disease, according to researchers at the National School of Tropical Medicine in Houston. That compares with one in every 27,500 donors across the U.S.

The rate is higher in some parts of South Texas, where an estimated 1 in 3,000 donors are infected, experts say. Half of the infected donors acquired the disease in Texas.

Blood centers began voluntarily testing donors for the parasite in 2007. Since then, blood screening has identified more than 2,000 infected donors.

The parasite is spread to humans and dogs through the bite of a kissing bug, an insect that lives in rats’ nests or wood piles or in the nooks of furniture or cracks in homes. Chagas disease is also spread through pregnancy from mother to baby, as well as through organ transplants and blood transfusions.

But blood donors are tested only once for Chagas disease under the current protocol outlined by the Food and Drug Administration. First-time donors who have a negative test are never screened again.

Three federal agencies work with blood banks to monitor threats to the blood supply. The FDA sets guidelines for blood screening, the U.S. Centers for Disease Control and Prevention performs disease surveillance, and the National Institutes of Health researches the science of blood safety.

Nearly 10 million Americans donate blood each year. Four components of donated blood — red cells, platelets, plasma and cryoprecipitate — are given to an estimated 5 million patients a year.

Blood is screened for HIV, syphilis, West Nile virus, hepatitis B and C and other viruses and bacteria each time a person donates blood. New technologies that inactivate blood pathogens including HIV, malaria and the parasite that causes Chagas disease have been recently approved by the FDA.

Intercept

One of these technologies, the INTERCEPT Blood System, has been used in 20 European countries since 2003. It is now used by some blood centers in Florida and Delaware, and there are plans for its use within the next year at a Colorado blood center and at the National Institutes of Health in Maryland.

The system, made by Cerus Corp. in Concord, Calif., works on plasma and platelets. It uses a chemical that latches on to the genes of various pathogens. The blood is then exposed to ultraviolet light, which tightly binds the chemical to the genes so the pathogens cannot replicate. Plasma and platelets are not affected because they don’t contain genes.

Blood centers in Texas are not using the technology. Blood screening guidelines set out by the FDA do not call for the use of systems such as INTERCEPT. But states and blood centers can choose to go above and beyond federal guidelines.

“We do still screen donors for Chagas by asking them about their health,” said Dr. Laurie Sutor, vice president of medical and technical services at Carter BloodCare, the largest blood supplier in Texas.

“We ask if they feel well,” said Sutor, referring to a questionnaire that donors fill in before they give blood.

Capture
But many people infected with Chagas disease feel well for decades. That’s because the parasite can lie dormant for 20 to 30 years before causing heart and gut symptoms.

One in three people infected with the parasite will develop chest pain, fatigue and breathlessness from heart failure that can be fatal. One in 10 suffer damage to the nerves and gut. Between 1 percent and 10 percent of pregnant women pass the parasite on to their babies.

“Americans are sitting ducks waiting for an epidemic to happen,” said Dr. Richard Benjamin, chief medical officer at Cerus. From 2002 to 2015, Benjamin was chief medical officer at the American Red Cross, where he supervised donor and patient safety.

One-time screening might be appropriate in states where Chagas disease is not common, he said, but in Texas, where rates are higher, there should be a more rigorous protocol.

Sutor disagrees. “The experts in our field feel that the current screening methods are accurate even in Texas because the evidence right now is that Chagas is not being transmitted by blood transfusions,” she said.

The CDC and FDA say that Chagas disease can be spread by blood transfusions. In a 2010 FDA guidance document for blood banks, the agency said that transfusion-related Chagas disease infections are “not likely to be diagnosed, and in many cases, even if symptoms appear, infection may not be recognized.”

Seven people have been infected with Chagas disease after receiving blood transfusions in the U.S. and Canada, according to the FDA. Five have been infected after organ transplantation. Since screening began, two people have been infected from platelet transfusions.

The same FDA document says that in Los Angeles, one in every 2,000 blood donors may be infected with the Chagas-causing parasite. “That’s really a very high number,” said Benjamin. “Much higher than for any other infectious disease that we deal with routinely, like hepatitis or HIV.”

The FDA declined to be interviewed, as did the chair of its blood safety committee. In an emailed statement, an FDA spokesperson said the agency continues to work with the CDC and National Institutes of Health to monitor threats to blood safety and ensure that the medical community is aware of risks associated with blood transfusions.

Another tropical disease that can spread through transfusions is West Nile virus. By the time blood banks started screening for the virus in 2003, at least 23 people had been infected by tainted blood.

West Nile virus and the parasite that causes Chagas disease aren’t the only tropical agents threatening the safety of the blood supply.

Chikungunya, a virus spread by mosquitoes, has caused outbreaks in the Caribbean in recent years, and experts warn that it could become established in Texas.

The risk is that when a traveler brings the virus to Texas, the virus could circulate among local mosquitoes and become established in mosquitoes and humans.

A chikungunya epidemic in Puerto Rico last year forced a shutdown of the local platelet donation system. The American Red Cross stopped accepting donations from locals and had to import platelets from the continental U.S.

Benjamin fears a similar situation could occur in Texas.

“I’m concerned, and I think there should be a more general concern than there seems to be,” he said. “It’s time to consider Chagas again and look to see if what we are doing is correct or not.”